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Cannabis use is associated with improved outcomes in opioid-dependent subjects undergoing outpatient treatment, according to data published online ahead of print in the journal Drug and Alcohol Dependence.

Researchers at Columbia University assessed the use of cannabinoids versus placebo in opioid-dependent subjects undergoing in-patient detoxification and outpatient treatment with naltrexone, an opiate receptor antagonist. Investigators reported that the administration of oral THC (dronabinol) during the detoxification process lowered the severity of subjects’ withdrawal symptoms compared to placebo, but that these effects did not persist over the entire course of treatment. By contrast, patients who consumed herbal cannabis during the outpatient treatment phase were more readily able to sleep, were less anxious, and were more likely to complete their treatment as compared to those subjects who did not.

“One of the interesting study findings was the observed beneficial effect of marijuana smoking on treatment retention,” authors concluded. “Participants who smoked marijuana had less difficulty with sleep and anxiety and were more likely to remain in treatment as compared to those who were not using marijuana, regardless of whether they were taking dronabinol or placebo.”

The findings replicate those of two prior studies, one from 2001 and another from 2009, reporting greater treatment adherence among subjects who consumed cannabis intermittently during outpatient therapy.

Population data from states where medicinal cannabis is permitted report lower rates of opioid-abuse and mortality as compared to those states where the plant is prohibited. Clinical data and case reports also indicate that the adjunctive use of cannabis may wean patients from opiates while successfully managing their pain. Survey data of state qualified medical cannabis patients demonstrates that subjects with access to the plant often substitute it for opioids because they perceive it to possess fewer adverse side effects.

Overdose deaths involving opioids have increased dramatically in recent years. While fewer than 4,100 opiate-induced fatalities were reported for the year 1999, by 2010 this figure rose to over 16,600 according to an analysis by the US Centers for Disease Control.

An abstract of the study, “The effects of dronabinol during detoxification and the initiation of treatment with extended release naltrexone,” appears online here.

For decades opponents of marijuana law reform policies have falsely argued that marijuana is a ‘gateway’ to drug abuse — a guilt-by-association charge that implies that because tens of millions of people have used cannabis and a minority of these tens of millions have also tried other drugs that somehow it must have been the pot that triggered the hard drug use.

But while reformers have been consistent — and accurate — to point out that the so-called ‘gateway theory’ lacks any statistical support (for example, the U.S. government contends that more than four in ten Americans have used cannabis, yet fewer than two percent have ever tried heroin), few in our movement have publicized the fact that for many people cannabis can be a powerful ‘exit drug’ for those looking to curb or cease their use of alcohol, opiates, or narcotics. For instance:

A 2010 study published in the Harm Reduction Journal demonstrating that cannabis-using adults enrolled in substance abuse treatment programs fared equally or better than nonusers in various outcome categories, including treatment completion.

A 2009 survey published in the Harm Reduction Journalfinding that 40 percent of respondents said used marijuana as a substitute for alcohol, and 26 percent used it to replace their former use of more potent illegal drugs.

Based on this and other emerging evidence, investigators at the Harborside Health Center in Oakland, California are now enrolling residents in twelve-step-like classes that use cannabis to quit heroin, pills, cigarettes, alcohol, and other potentially addictive substances.

For years, there have been anecdotal reports about people using cannabis to quit harder drugs. The process is called “substitution”, and it’s a tactic that’s beginning to be endorsed by the “harm reduction” philosophy of mental health.

… So Harborside crafted a program that’s similar to traditional twelve-step programs, but ignores the pot smoking.

… Janichek is tracking the outcomes of Harborside’s free, cannabis-positive mental health services, with the goal of extrapolating the data into guidelines and replicating the services in other dispensaries.

It will be interesting to see the results of this program in the coming months — as well as the response (read: outcry) from the traditional drug treatment community.

One can expect that Harborside’s findings will further undermine the notion that cannabis is an alleged ‘gateway’ to hard drug use, and strengthen the argument that the plant may, in fact, be a useful tool for deterring the initiation or continuation of drug abuse.